LEAH PTO Request Form

LEAH PTO Request Form
Name

First NameLast Name
This PTO request is for the pay period beginning on Date and ending on Date . I understand that my requested hours can not exceed 40hrs/wk including hours worked.
VacationLeave of AbsencePregnancyIllness/InjuryJury DutyBereavementCOVID-19 RelatedPersonalOther
PTO Hours requested
Notes if additional information is required or requested:
By signing, I am authorizing the use of my paid time off (PTO) for the time absent from work. Please include the above number of hours on the appropriate pay period for the time requested or taken.
Signature
Date

MonthDayYear
Date
Should be Empty: